Free healthcare template
Patient Satisfaction Survey template
A 1-minute satisfaction check after a visit, with follow-up on low scores. Ready to use: open it, change anything you like and share it in minutes.
Free forever plan · No card required · 4 questions · About 1 min to fill
What's in this template
These are the actual questions. Edit, remove or add your own in the builder.
- 1How satisfied were you with your visit today?*Star rating
- 2We're sorry. What could we have done better?Paragraph
- 3Would you like someone from our team to call you?Yes / No
- 4Your phone numberPhone
How to make your patient satisfaction survey
Use this template free
Create a free account. The template opens in the builder, ready to edit. No card required.
Make it yours
Change questions, add your logo and colours, pick a theme and background, and set who gets notified.
Share and collect
Publish, then share the link, embed it on your site or print the QR code. Responses arrive with charts.
Questions about this template
Is this patient satisfaction survey template free?
Yes. Create a free Airform account, open the template and publish it. The Free plan needs no card, and your form stays live even if you reach the monthly response allowance.
Can I change the questions?
Every question, option and screen can be edited in the builder: add or remove questions, change the wording, reorder by dragging and apply your own theme and colours.
How do I share the patient satisfaction survey?
Publish it and share the link, embed it on your website, or download a QR code for posters, counters and printed material. On Professional, each link or QR code can be tracked as its own campaign.
Where do the responses go?
Every response appears in Airform with charts and filters, can be exported to CSV, and can be sent to OPM CRM as a lead with its source and consent.
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Start with the patient satisfaction survey template.
It takes a minute to make it yours. Free, with no card required.